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Feb 16, 2016 • 28min

E-cigarettes, Asherman's syndrome, Rugby

The UK's first licensed e-cig, owned by a tobacco company, is now classed as a medicine paving the way for it to be prescribed on the NHS to help people quit. Robert West, Professor of Psychology at University College London and one of the world's leading experts on smoking cessation, and GP Margaret McCartney debate the issues.Asherman's Syndrome, a little known complication of surgery that is often missed but can cause infertility. Obstetrician Virginia Beckett explains how Asherman's Syndrome occurs and how it is treated.Rugby is growing in popularity, particularly among children, with 1.2 million of them now playing at schools and clubs in England alone. But at what cost? Rugby is rough and injuries are more common than most parents think.After her son and other young people were hurt repeatedly on the rugby field, Allyson Pollock, Professor of Public Health Research and Policy at Queen Mary, University of London, explored the incidence of injuries. From her research she is now recommending an end to the contact element of rugby in young people. Rugby Football Union's community medical director Dr Mike England responds.
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Feb 9, 2016 • 28min

Chicken pox in pregnancy, Club foot, Test for Conn's syndrome, Teeth brushing

Dr Margaret McCartney reviews advice to pregnant women concerned about the Zika virus while Andrew Shennan, Professor of Obstetrics at King's College and St Thomas' Hospital in London tells Dr Mark Porter about the risks of infection closer to home - chicken pox.One in every one thousand babies born in the UK has congenital talipes, or club foot. This is where the foot points inwards and downwards, the sole facing backwards. But thanks to the late Ignatio Ponseti, an orthopaedic surgeon from Iowa in the USA, 95% of children born with club foot will make a complete recovery. Dr Ponseti was concerned about the low success rate of surgical treatment, which often resulted in life-long pain and stiffness and a 50% chance of recurrence. He developed a new technique in the 1960's that involves stretching the foot, holding it in plaster casts and eventually braces. The problem was that nobody believed him and it wasn't until the early 2000's that his technique became the new gold standard for club foot treatment - the news spread by his patients and their parents using the internet. Mark visits the club foot clinic at The Royal London Hospital, which sent a team, led by consultant paediatric orthopaedic surgeon, Manoj Ramachandran to study with Dr Ponseti at his Iowan clinic. Mark meets Hannah, whose 8 week old baby, Penelope, is just beginning treatment and hears from Claire, whose son, Lucas, now four years old, has, post-treatment, two perfect feet. Professor of Endocrine Hypertension at Queen Mary University London, Morris Brown, gives more details about the test for Conn's Syndrome - which could account for as many as one in ten cases of high blood pressure. And Inside Health listener Howard, calls on Mark to settle a teeth cleaning dispute between him and his wife. Should you brush before or after breakfast? The British Dental Association's Chief Scientific Officer, Professor Damian Walmsley adjudicates.
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Feb 2, 2016 • 28min

Blood pressure, Palm oil

How low should you go when treating blood pressure? Mark Porter talks to the author of landmark study that was stopped early because the benefits of aggressive treatment were so convincing. This looks set to change the management of high blood pressure and millions more people in the UK will be taking extra medication. Dr Margaret McCartney debates the issues with Professor Tony Heagerty.Imagine if your high blood pressure could be cured by an operation that meant no pills at all? That's possible if it's due to a condition called Conn's syndrome, now thought to be much more common than previously thought. Mark Porter hears from leading specialist, Professor Morris Brown, plus a school teacher who spent 10 years on pills before being diagnosed and is now cured.And an Inside Health listener asks: why is palm oil in everything?
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Jan 26, 2016 • 28min

Folic acid in flour, Southampton FC and hip and groin pain, Online private doctors

Scotland is considering whether to add folic acid to staple foods like flour to protect babies against conditions like spina bifida. Frustrated at the lack of action by the UK government on the issue - despite government advisers recommending for 16 years that flour should be fortified with folic acid - the Scottish government is preparing to go it alone. Spina bifida is one of a group of severe congenital abnormalities known as neural tube defects that affect around 5000 developing babies in Europe every year. It's long been known that taking folic acid supplements, before and after pregnancy, can reduce the likelihood of these defects, as Helen Dolk, Professor of Epidemiology at the University of Ulster explains to Dr Mark Porter. Professional footballers are vulnerable to hip and groin injuries and much more likely to get arthritis as they get older. Southampton Football Club has introduced a new hip stretch and flexibility programme for all their players and the result is a dramatic reduction in injuries. Mark visits the club and meets Olufela Olomola, who, before his transfer to The Saints, spent a season on the bench with hip and groin injury at Arsenal. Just a season later he's recovered and now captains The Saints under 18 team. Mo Gimpel, Director of Medical and Science Performance Support at Southampton FC says the decision to focus on hip flexibility came several years ago, after serious hip and groin injury was keeping key players off the pitch, and the club was losing matches. The new pre-activation sessions have transformed the club's injury rates and research teams are partnering the club to find out how hip impingement develops in the first place. Professor Sion Glyn-Jones from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences is leading a group tracking 110 young players from The Saints' Footballing Academy, a league two club, a cricket club and pupils from local schools. Detailed mechanical and imaging studies of these young players' hips will help to show exactly when hip injury, or femoroacetabular impingement, first appears, what causes it and most importantly, how to prevent it in the first place. Private medical helplines providing 24/7 advice are the latest development in private medicine. New companies are popping up, attracting millions in private finance. They offer people access by e-mail, phone or online visual link to a GP consultation, for a fee. Dr Karen Morton, founder of DrMortons.co.uk tells Mark why she believes pressure on primary care will result in an inevitable rise in demand for such services. People who want reassurance and advice, she says, can use such helplines and avoid clogging up GP waiting rooms with relatively minor complaints. But Dr Margaret McCartney disagrees and says phone-only consultations risk fragmenting medical records and undermining the relationship between a GP and their patient.
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Jan 19, 2016 • 28min

Hospital admissions and the 'weekend effect', Peyronie's disease

Dr Mark Porter unpicks the science behind the so called 'weekend effect'. Politicians have quoted research claiming that people are 20% more likely to die of a stroke at the weekend, while another much cited study finds 11,000 more deaths in people admitted at the weekend. But how valid are these figures and the research that generated them? Dr Margaret McCartney reviews the stroke data that has been criticised by experts as being out of date. While Mark Porter talks to Editor of the BMJ, Fiona Godlee, who published the 11,000 figure but is concerned about the political use of the findings. And discusses the study with lead author Nick Freemantle, plus Consultant Surgeon Sam Nashef who is sceptical about the results.
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Jan 12, 2016 • 28min

Health and Exercise Inside Health Special

Inside Health listener and keep fit enthusiast, David Heathcote, wanted advice on how far he should safely push himself when he's training in the gym.In this special programme about the health benefits of keeping active, Dr Mark Porter helps David to find the answer to his question about the exercise "sweet spot". If you struggle to screw the top off a jar, or use your arms to push yourself out of your chair, that's a sure fire sign, according to Dr Philip Conaghan, consultant rheumatologist and Professor of Musculoskeletal Medicine at the University of Leeds, that your muscles are weak. And the good news is that building muscle strength will protect your joints, not damage them. Dr Conaghan tells Mark that there's a worrying lack of understanding about the impact of muscle weakness on arthritic joints.Over the last decade there's been a growing interest in the relationship between activity and the risk of developing cancer. Studies have demonstrated that exercise appears to have a protective effect against at least four different cancers (breast cancer, colon cancer, endometrial cancer and some upper gastrointestinal cancers) and that being fit helps recovery from cancer too. Dr Denny Levett, a consultant in peri-operative medicine and critical care at University Hospital, Southampton who has a special interest in the relationship between exercise and health, says the reason for the apparent protective effect of fitness is still being researched but the evidence that the effect exists is now widely accepted. Professor of Clinical Cardiology, Sanjay Sharma from St George's University of London outlines the benefits to our hearts of keeping active and Park Run fan and regular Inside Health contributor, Dr Margaret McCartney, admits how running has become something of an obsession and promises that the evidence shows that when it comes to getting fitter, it's never too late to start.
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Oct 6, 2015 • 28min

Pregabalin and gabapentin misuse, Natural birth after caesarean, Adrenaline auto-injectors

Prescriptions for nerve drugs pregabalin and gabapentin have risen dramatically in recent years and at the same time, concerns about abuse. Former prisoner and addict "Patrick" tells Dr Mark Porter that "gabbies" or "pregabs" are drugs of choice in jail and Dr Iain Brew, a GP who works in prisons, says misuse is a growing problem and there are examples of doctors being pressurised into prescribing them. Dr Cathy Stannard, consultant in pain medicine at Southmead Hospital in Bristol, chaired an expert group that drew up new prescribing guidelines for pregabalin and gabapentin and she tells Mark that more attention needs to be paid to emerging evidence of misuse. Many women say that if they've had one caesarean section, they feel pressurised to have another one and Sara describes how her medical team planted "a seed of doubt" about the potential risks to her baby which she says for her meant another C-Section was inevitable. But new guidelines from the Royal College of Obstetricians and Gynaecologists spell out that vaginal birth after a previous caesarean is a clinically safe choice, with a 75% success rate, the same as for first-time mothers. Inside Health's Dr Margaret McCartney discusses the history of changing attitudes to natural birth after caesarean and says why the new guidelines should give future mothers the confidence to discuss, well in advance of their birth, the best option for them. How do you fill in health check forms that ask for family history if you don't know who your family was? Inside Health listener Jessica is adopted and her heart health check suggested a very low risk of a stroke or heart attack when she couldn't answer the family history question. Mark and Margaret discuss how common this is, and what difference family knowledge would make to Jessica's risk (not much).Adrenaline auto injectors were first used in the 1960s when they were developed for soldiers to use during nerve gas attacks allowing them to self administer the antidote. But is a device designed to be used by fit, trained soldiers just as suitable for use in children and adults of widely varying size and weight? These concerns were raised by a coroner conducting the inquest into the death of a 19 year old student who died of anaphylactic shock caused by a nut allergy, despite her using her auto injector. The Medicine and Healthcare Products Regulatory Authority and also the European Medicines Agency have been looking into issue and Dr Robert Boyle, allergy specialist at St Mary's Hospital, Paddington and Director of the Paediatric Research Unit at Imperial College, London provided expert advice. He talks to Mark about the limitations of auto injector design and urges everybody who might use the devices to ensure they are confident about exactly how to use them.
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Sep 29, 2015 • 28min

Pollution, Falls in the elderly, False positives and negatives, Meningitis B and teenagers

As cars were banned from central Paris this weekend and the health risks of pollution hit the headlines, Mark Porter examines the statistic that pollution kills 29,000 people a year in the UK.And he visits a pioneering clinic at Southampton General Hospital where falls in the elderly are seen as a risk factor for underlying health problems; 'Having a hip fracture is like having a heart attack or stroke' explains Dr Mark Baxter. 50% of people who have a hip fracture will have previously presented with a fall, but once they go on to break a hip, 1 in 10 elderly people may not be alive at the end of the month and up to 25% by the end of the year. Many elderly people are found to be on multiple treatments - blood pressure pills or bladder pills for example - that make people fall over. In recent years there has been much more attention paid to the cumulative burden of the side effects of medicines in the elderly - particularly the group of commonly used drugs known as Anticholinergics. And according to new research by a team at the University of East Anglia, taking Anticholinergics increases the risk of falls too - particularly in men.Following news of the Meningitis B vaccine in children, an Inside Health listener got in touch to ask why it wasn't being given to teenagers in light of data showing that there is a second peak in incidence in the disease among 15 - 19 year olds? Mark talks to Professor Andrew Pollard, Chair of the Joint Committee on Vaccination and Immunisation.And Inside Language: Dr Margaret McCartney and Professor Carl Heneghan demystify the terminology of medicine and research. This week, false positives and false negatives; when is something not what it seems, and when does it seem what it's not?
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Sep 22, 2015 • 28min

Cancer drugs fund, Winter flu vaccine, Bandy legs and knock knees, Peer review

For five years the Cancer Drugs Fund has supplied seventy five thousand patients in England with cancer drugs, but its days are numbered. Spiralling costs have led to a reduction in the number of drugs the CDF will pay for, meaning newly-diagnosed patients may miss out. Dr Mark Porter talks to Vicky Rockingham about the anxiety that reform of the CDF is causing. Vicky is a mother of two, working full time, and receiving regorafenib paid for by the CDF for her rare type of gastrointestinal stromal tumour, or GIST. She tells Mark that the drugs from the CDF are giving her extra time with her family and enabling her to carry on working. And Jonathan Pearce, Chair of Cancer 52, an alliance of organisations that represent people with less common and rarer cancers like Vicky's, tells Mark why any new-model CDF must take into account individual patient needs. Regular Inside Health contributor, Dr Margaret McCartney, describes how patients access cancer drugs in Scotland, Wales and Northern Ireland and discusses with Mark the difficult decisions that access to expensive and innovative new cancer medicines present for the NHS.Last season's winter flu vaccine provided only limited protection to those who received it. An exceptional year where there was a mismatch between the flu virus that eventually circulated, and the vaccine that had been developed by international teams. The result was just 30% protection (down from its usual 70-80%). Dr Mark Porter asks the chair of the Joint Committee on Vaccination and Immunisation (JCVI), Professor Andrew Pollard, whether confidence in this year's vaccine could be dented.Babies, toddlers and pre-school children often seem to have bow legs and knock-knees and parents frequently turn up at their doctor's surgery asking for reassurance about the way their children walk. Manoj Ramachandran, consultant children's orthopaedic and trauma surgeon based at The Royal London and Bart's Hospital tells Mark that up to a quarter of the children referred to his clinics have normal, developmental lower limb variants. Children are naturally bow legged when they first walk and by the age of three, there's another natural re-alignment which tends to lead to knock knees. At both these ages his clinic receives a peak in referrals but by the age of seven, he says, most childrens' legs straighten up naturally.Inside Language: Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford and Dr Margaret McCartney continue to demystify the scientific language of medicine. This week, peer review.Producer: Fiona Hill.
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Sep 15, 2015 • 28min

League tables, Nits, Feeling the cold, Language - Surrogate marker

Are league tables listing surgical outcomes the best way to assess your surgeon or are high risk patients being turned away as surgeons keep an eye on their figures? New data published this week list the clinical outcomes for heart surgery - cardiac surgeons are just one speciality from an ever expanding list of doctors whose performance is now published in league tables and subject to public scrutiny. But what impact has their introduction had on patient care? Sam Nashef, a consultant cardiac surgeon at Papworth Hopsital, discusses this issue with Mark Porter.Recent research in schools in Wales suggest that as many as one in 12 primary school children get them at this time of year - and that compares favourably with Australian research, which suggests the figure's much higher - closer to one in five. Resident sceptic Dr Margaret McCartney explains which treatments are supported by evidence.Lyn e-mailed Inside Health to understand why she often feels colder than other people. How, she asked, do we regulate our body temperature and are some people better at it than others? George Havenith is Professor of Environmental Physiology and Ergonomics at Loughborough University, and Mike Tipton, Professor of Human and Applied Physiology at the University of Portsmouth, provide answers.And in the next of our special series demystifying the language of research and statistics Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford and Dr Margaret McCartney unpack the concept of surrogate markers. These feature increasingly in medical research and can involve everything from blood test results, to the pattern on your heart trace or ECG.

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